HealthIntel Weekly: Centene Posts High MA Prior Authorization Volume and Denial Rate in 2024
Welcome to HealthIntel Weekly. Every week, we pull together the latest health care reports, research, and upcoming webinars so you don’t have to dig for them.
What’s New:
Medicare Advantage insurers made nearly 53 million prior authorization determinations in 2024, with 7.7% denied in full or in part, according to a KFF analysis. That denial rate is slightly higher than the 6.4% in 2023 and comparable to levels seen in 2022. Only 11.5% of denied requests were appealed, though more than 80% of appeals resulted in overturned decisions. On average, MA beneficiaries faced about 1.7 prior authorization requests per person, down modestly from 1.8 in 2023, largely because enrollment grew faster than the number of requests. Requests per enrollee varied widely across MA insurers, ranging from 0.6 at Kaiser Foundation Health Plan to 3.0 at Elevance Health and Centene plans. UnitedHealth Group denied the highest share of requests (12.8%), followed by Centene (12.3%) and CVS Health (11.9%), while Elevance had the lowest denial rate (4.2%).
Throughout 2025, more than 1,000 brand-name drugs posted wholesale acquisition cost (WAC) increases, with median price hikes of about 4%, according to a 46brooklyn Research analysis. Major drugs such as Novo Nordisk’s Ozempic, Gilead’s Biktarvy and Sanofi’s Dupixent were among those with notable impact. Early 2026 data show continued list price activity, with roughly 872 brand-name products taking WAC increases and 18 posting decreases. However, manufacturers implemented substantial list price cuts, ranging from 42% to 75%, for six drugs subject to Medicare’s Maximum Fair Prices under the Inflation Reduction Act. The scale of these reductions more than offsets modest increases elsewhere, resulting in a net negative impact on Medicaid spending.
About 23 million people have selected 2026 individual market coverage through HealthCare.gov and state-based exchanges since the start of the Marketplace open enrollment period on Nov. 1, 2025, according to CMS. That total includes approximately 3.4 million new enrollees and 19.6 million returning consumers. Of those, 15.8 million selected plans through HealthCare.gov, while 7.2 million enrolled via state-based exchanges. However, this snapshot may not fully reflect paid enrollment, according to an analysis from Georgetown University’s Center on Health Insurance Reforms. Early data from state-based marketplaces show rising cancellations and a shift toward plans with higher out-of-pocket costs. Middle-income consumers, in particular, have experienced steep 2026 premium hikes following the expiration of enhanced premium subsidies.
Next Up:
Employers Beware: Hidden Risks of 340B Shared Savings Models
National Alliance of Healthcare Purchaser Coalitions, Feb. 3, 2026, 3 p.m. (ET)
Panelists:
Shawn Gremminger, President & CEO, National Alliance
John Cerulli, Senior Manager, Health Policy & Strategic Communications, Reservoir Communications Group
The FDA and Its Changing Relationship to Industry
Health Affairs, Feb. 17, 2026, 11 a.m. (ET)
Panelists:
Genevieve Kanter, USC Sol Price School of Public Policy
Holly Fernandez Lynch, Perelman School of Medicine at the University of Pennsylvania
Chris Meekins, Raymond James
Rachel Sachs, Washington University in St Louis (Moderator)
What Excites Insiders About Health Care in 2026?
Health Affairs, Feb. 25, 2026, 1 p.m. (ET)
Panelists:
Martin Cauz, Beechwood Consulting Group
Renée Landers, Suffolk University Law School on the Health Equity Compact
Mark Speicher, American Association of Colleges of Osteopathic Medicine
Michael Gerber, Health Affairs (Moderator)
Excellent breakdown of the KFF data. That 11.5% appeal rate despite 80% overturn success is wild tbh. The friction cost of appealing clearly works as intended by insurers, even when denials are demonstrably wrong. I've seen providers just eat the cost rather than deal with the appeals backoffice burden. Puts the whole prior auth debate in sharper focus when denial becomes profitable regardless of medical necesity.